{"title":"Spinal hematoma","authors":"Sandra L. Kopp MD","doi":"10.1016/j.spmd.2004.09.003","DOIUrl":"https://doi.org/10.1016/j.spmd.2004.09.003","url":null,"abstract":"<div><p><span><span>Spinal hematoma is a very rare </span>neurologic disorder<span> with the potential to cause paralysis or death if not treated appropriately. Prompt diagnosis appears to be the most important aspect of assuring successful treatment and positive outcomes. There are several etiologies of spinal hematoma, such as spontaneous bleeding, trauma, coagulopathies, </span></span>vascular malformations<span><span><span>, and iatrogenic hemorrhage during lumbar puncture or </span>neuraxial anesthesia. Although a spinal hematoma can occur in the pain clinic during procedures such as epidural steroid injections, it is very rare. Most of the available clinical information comes from small case series and isolated case reports of patients undergoing neuraxial anesthesia procedures. This article will not only offer the reader general information about spinal hematomas, it will summarize the current literature with respect to recommendations regarding neuraxial procedures during </span>anticoagulant administration.</span></p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 4","pages":"Pages 237-243"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.09.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138399151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neural injury after interventions for chronic pain","authors":"Randall P. Brewer MD","doi":"10.1016/j.spmd.2004.09.011","DOIUrl":"10.1016/j.spmd.2004.09.011","url":null,"abstract":"<div><p><span>Interventions for chronic pain are important in the diagnosis and treatment of many disorders causing chronic pain and suffering. Injury to the peripheral or central nervous system is a rare but important cause of morbidity and mortality following chronic pain interventions. Mechanisms of neural injury include </span>neural ischemia<span>, compression from hematoma, abscess, granuloma, and neurotoxicity<span>. This review will highlight the pathophysiology of neural injuries, review the literature regarding specific injuries and mechanisms, and suggest practical guidelines for injury prevention.</span></span></p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 4","pages":"Pages 244-251"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.09.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90927457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anterior spinal artery syndrome as a complication of transforaminal epidural steroid injections","authors":"Marc A. Huntoon MD","doi":"10.1016/j.spmd.2004.09.010","DOIUrl":"10.1016/j.spmd.2004.09.010","url":null,"abstract":"<div><p><span>Corticosteroids are commonly injected in the lumbar and cervical epidural space as a treatment for </span>radiculitis<span>. Historically, the epidural injections<span> have been via an interlaminar technique but the transforaminal approach is becoming more prevalent. As the number of transforaminal procedures has increased, there have also been an increasing number of case reports of anterior spinal artery<span> ischemic events leading to temporary and permanent neurological deficits or death. Aside from death, neurological compromise is the most feared complication of all for interventional pain physicians, and strategies to avoid the occurrence of these events are necessary. This review of complications will focus on the type and location of complications, anatomy of anterior spinal cord blood supply, description of the anterior spinal artery syndrome, discussion of potential etiologies, and suggested preventative strategies.</span></span></span></p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 4","pages":"Pages 204-207"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.09.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82785720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Complications of nonopiate pharmacotherapy","authors":"W.David Mauck MD , Mark-Friedrich B. Hurdle MD","doi":"10.1016/j.spmd.2004.09.009","DOIUrl":"10.1016/j.spmd.2004.09.009","url":null,"abstract":"<div><p><span>The intention of this article is to review complications associated with the more commonly used nonopioid medications prescribed for pain control. The medications discussed are limited to those commonly prescribed to the adult patient in the outpatient setting and include nonsteroidal antiinflammatory drugs, </span>acetaminophen<span><span>, anticonvulsants, tricyclic antidepressants, and </span>topical agents. Only limited discussion is given to medication administered intravenously, intramuscularly, epidurally, intrathecally, or injected. Emphasis is placed on common reactions, life-threatening reactions, drug interactions, and safety in pregnancy.</span></p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 4","pages":"Pages 220-227"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.09.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89094686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infectious complications of commonly performed spinal injections","authors":"W.Michael Hooten MD","doi":"10.1016/j.spmd.2004.09.008","DOIUrl":"10.1016/j.spmd.2004.09.008","url":null,"abstract":"<div><p><span><span>Infections after spinal injections are rare but devastating complications. The purpose of this review is to provide an evidence-based assessment of the case report literature to characterize the predisposing epidemiological and clinical features of patients who developed infectious complications after commonly performed spinal injections. All patients received a corticosteroid as part of the injection. The mean time to symptom onset from the last injection was 14 days, during which patients presented with worsening </span>spinal pain<span><span> and the onset of new neurological symptoms. The most common type of infection was an </span>epidural abscess, while the most frequently cultured organism was </span></span><span><em>Staphylococcus aureus</em><em>.</em></span><span><span> The presence of an underlying medical illness that adversely impacts immune function could represent a potential risk factor for development of an epidural abscess. Immunocompromised patients should be identified before performing an </span>epidural injection<span>, and antibiotic prophylaxis for </span></span><em>S. aureus</em> should be considered.</p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 4","pages":"Pages 208-214"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.09.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87633798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Differential diagnosis of low back pain","authors":"Elizabeth Huntoon MD , Marc Huntoon MD","doi":"10.1016/j.spmd.2004.08.003","DOIUrl":"10.1016/j.spmd.2004.08.003","url":null,"abstract":"<div><p>Low back pain is a symptom affecting millions of adults annually. The etiology of low back pain may be difficult to determine at times because of the number of diverse anatomic structures located in or near the low back region. These structures may be causing direct or referred pain patterns. An accurate diagnosis is essential for both acute and chronic low back pain conditions. The discussion in this article is extensive but not all-inclusive, and the clinician should consult other sources for more detailed description of the less common differential diagnoses.</p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 3","pages":"Pages 138-144"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76877474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven P. Stanos DO , P. Michelle Muellner MD , R. Norman Harden MD
{"title":"The physiatric approach to low back pain","authors":"Steven P. Stanos DO , P. Michelle Muellner MD , R. Norman Harden MD","doi":"10.1016/j.spmd.2004.08.006","DOIUrl":"10.1016/j.spmd.2004.08.006","url":null,"abstract":"<div><p><span>The physiatric approach to low back pain is functional and interdisciplinary. Physiatry approaches the patient from the physical, psychological, and social perspectives to obtain a thorough understanding of his or her goals and needs. Once the assessment is complete, treatment focuses on reducing pain; restoring ability to participate in activities of daily living, work, and recreation; achieving patient independence with care; and reducing dependence on the health care system. This treatment is achieved through the use of a cognitive-behaviorally based interdisciplinary rehabilitation approach, which combines the use of therapeutic exercise<span>, body mechanics and ergonomics, </span></span>biofeedback, modalities, medications, and vocational counseling.</p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 3","pages":"Pages 186-196"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.08.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86566403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert A. Swarm MD , Menelaos Karanikolas MD , Rahul Rastogi MB, BS , Myint Maw MB, BS, MPH
{"title":"Pharmacological options for low back pain","authors":"Robert A. Swarm MD , Menelaos Karanikolas MD , Rahul Rastogi MB, BS , Myint Maw MB, BS, MPH","doi":"10.1016/j.spmd.2004.08.005","DOIUrl":"10.1016/j.spmd.2004.08.005","url":null,"abstract":"<div><p>Analgesics<span> are important in the management of low back pain, but their role is currently limited by the efficacy of available pharmacological options. Recent progress in pain research has greatly increased understanding of the pathophysiology of pain and the mechanisms of actions of analgesic agents, but the translation of research progress into new clinical treatments has been slow. Nonetheless, currently available agents (nonopioid, opioid, and adjuvant analgesics) have established utility in the management of moderate and severe pain. While awaiting new research developments, clinicians can improve symptom control and patient care in persons with low back pain now by optimizing use of available pharmacologic options.</span></p></div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 3","pages":"Pages 175-185"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2004.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86359708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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